Background: An improved understanding of which patients are at higher risk of recurrent venous thromboembolism (VTE) is important, as recurrence increases mortality and decreases quality of life. Although metabolic syndrome (MetS), the clustering of obesity, diabetes mellitus (DM), hyperlipidemia (HLD) and hypertension (HTN), has been associated with a hypofibrinolysis state, data linking VTE with MetS remain limited. The purpose of this study was to measure the prevalence of MetS in patients with deep vein thrombosis (DVT) across a large population and determine its impact on VTE recurrence.
Methods: We used the statewide Indiana Network for Patient Care database. All patients with a DVT diagnosis (based on ICD-9 or 10 coding) from 2005-2017 were included. We measured the frequency with which patients with DVT carried a comorbid ICD diagnosis of the MetS components. Data were analyzed using a multiple logistic regression model with VTE recurrence as the dependent variable and the following predictor variables: age, sex, HTN, HLD, DM, obesity, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure (CHF), anxiety, depression, stroke, myocardial infarction (MI), chronic kidney disease and smoking history.
Results: A total of 151,054 patients with DVT were included in this analysis. HLD was the most prevalent comorbid MetS component, present in 58% of all patients, followed by HTN (41%), DM (23%) and obesity (19%). 68% of total patients had at least 1 comorbid component of MetS. Recurrence of VTE occurred in 17% overall and increased stepwise with each criterion for MetS as follows: 7% recurrence in those with 0 components, 14% with 1, 21% with 2, 30% with 3 and 37% with 4. All 4 components of MetS had significant (95% CIs) odds ratios for VTE recurrence, with HLD having the largest magnitude odds ratio of 1.78, followed by obesity (1.52), HTN (1.47) and DM (1.42). The regression model identified all 4 components of MetS as independent predictors of VTE recurrence (p<0.001), representing the 4 largest magnitudes of coefficient of the 15 possible explanatory variables. Sex, CHF and MI were not significant
Conclusion: The presence of comorbid MetS components in patients with DVT is associated with higher rates of VTE recurrence, supporting the importance of recognizing these risk factors and initiating appropriate therapies to reduce recurrence risk.